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Semin Liver Dis 2025; 45(01): 129-143
DOI: 10.1055/a-2542-9930
Review Article

Recompensation in Cirrhosis: Biomarkers and Strategies

Wagner Ramírez-Quesada   *
1   Barcelona Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clínic, Institut de Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
2   Departament de Medicina i Ciències de la Salut, Fundació de Recerca Clínic Barcelona (FRCB-IDIBAPS), Health Care Provider of the European Reference Network on Rare Liver Disorders (ERN-RareLiver), Universitat de Barcelona, Barcelona, Spain
,
Edilmar Alvarado-Tapias   *   #
3   Centre for Biomedical Research in Liver and Digestive Diseases Network (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
4   Gastroenterology and Hepatology Department, Hospital Santa Creu i Sant Pau, Autonomus University of Barcelona, Barcelona, Spain
,
Sarah Shalaby
1   Barcelona Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clínic, Institut de Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
2   Departament de Medicina i Ciències de la Salut, Fundació de Recerca Clínic Barcelona (FRCB-IDIBAPS), Health Care Provider of the European Reference Network on Rare Liver Disorders (ERN-RareLiver), Universitat de Barcelona, Barcelona, Spain
,
Virginia Hernández-Gea   #
1   Barcelona Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clínic, Institut de Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
2   Departament de Medicina i Ciències de la Salut, Fundació de Recerca Clínic Barcelona (FRCB-IDIBAPS), Health Care Provider of the European Reference Network on Rare Liver Disorders (ERN-RareLiver), Universitat de Barcelona, Barcelona, Spain
3   Centre for Biomedical Research in Liver and Digestive Diseases Network (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
› Author Affiliations Financial Support and Sponsorship This work was supported by FIS 23/00997, funded by “Instituto de Salud Carlos III” and co-funded by the European Union. From “CIBEREHD” funded by “Instituto de Salud Carlos III.”  From the “Commissioner for Universities and Research from the Department of Economy and Knowledge” of the “Generalitat de Catalunya” (AGAUR SGR2021 01115).  S.S. has a Rio Hortega Grant. The current contract is funded by “Instituto de Salud Carlos III” with charges to the European funds of the Recovery, Transformation, and Resilience Plan (Plan de Recuperación, Transformación y Resiliencia), with files code CM23/00068, according to the Resolution of the Instituto de Salud Carlos III, O.A., M.P. of December 2023, granting the Rio Hortega Contracts, and “Co-Financed by the European Union.” EAT has a “Juan Rodés Post-Doctoral Grant” funded by “Instituto de Salud Carlos III” with file code (JR20/00047), and the PI21/01995 funded by “Instituto de Salud Carlos III” and co-funded by the European Union. We also thank the CERCA Program/Generalitat de Catalunya.
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Abstract

The onset of decompensation in advanced chronic liver disease (ACLD) is a hallmark in natural history, with a poor prognosis and a significantly increased liver-related mortality. Etiological treatments for viral hepatitis or abstinence in cirrhosis due to alcohol abuse have demonstrated that some patients experience partial to complete clinical and analytical improvement, a stage termed “recompensation.” Although recompensation is primarily defined clinically based on treatable etiologies, it is still evolving for conditions like metabolic dysfunction-associated steatotic liver disease (MASLD). Despite the need for specific biomarkers in hepatic recompensation, no biomarkers have been thoroughly studied in this context. Biomarkers identified in compensated ACLD (cACLD) following etiological treatment might be explored for recompensation. Although the pathophysiology mechanisms underlying the hepatic recompensation remain unclear, understanding the mechanism involved in cirrhosis decompensation could help identify potential targets for recompensation. This review provides an update on the hepatic recompensation concept, examines the existing data on invasive and non-invasive biomarkers, mainly in cACLD after cure, that could be raised in recompensation, and explores future therapeutic targets for the hepatic recompensation process.

Keywords

cirrhosis - portal hypertension - recompensation - variceal bleeding - MASH

* Shared first author.


# Shared corresponding author.




Publication History

Article published online:
03 April 2025

© 2025. Thieme. All rights reserved.

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